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1
APCase Studies

• Northland CollegeTerry Wiseth

Case StudiesIndex
2
CASE STUDIES INDEX
Case Study 1Case of the Mysterious Leg Pain
Case Study 2Case of the Chilling School Teacher
Case Study 3Case of the Poison Milk Shake
Case Study 4Case of the Double Jointed Athlete
Case Study 5Case of the Forgetful Soccer Mom
Case Study 6Case of the Salty Baby
Case Study 7Case of the Skinny Runner
Case Study 8Case of the Uptight Student
3
CASE STUDY 1

• CASE OF THE MYSTERIOUS LEG PAIN
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

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PatientReport Form
4
Click on one of the individuals below to gather
information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
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NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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6
Temperature is 98.4 OF
Patient has smoked for over 40 years and drinks
alcohol 2-3 times per week. He has not
experienced any nausea or headaches related to
this visit. Patient is a studio musician and is
widowed. He indicates that he urinates 8-10 times
per day and 2-3 times at night.
Oxygen Saturation is 91
Heart Rate is 65 beats / min
Height 510Weight 210 lbs
Blood Pressure is 140/86
Respiration Rate is 17 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is your name?How old are you?What sex are
you? What medications are you on?Do you have
any allergies?Where does it hurt?
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8
Pain started in my lower back a few weeks ago and
went down my leg across my thigh and over the
front of my knee. Now the pain seems to come from
my back to my upper chest and belly button.
High blood pressure pills
Hal Johnson
67 years old
Male
Eggs and cats
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What is your Name?How old are you?What sex are
you?Are you on any medications?Do you have any
allergiesWhere does it hurt?
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9
DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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10
Patient complains of leg pain that started in his
lower back, which then radiated down across the
side of his thigh and over the front of his knee.
Subsequently, he developed pain that radiated
from his back to his front at two different
levels at the chest through the level of his
nipples.
Wheezy
Palpations of neck, armpits, abdomen, groin all
indicate normally. A prostate examination
indicates a hard nodule.
Normal
Sclera clear, Ears and Throat no inflammation.
Good
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HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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LAB TECHNICIAN
The Lab Tech can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
Prostate Specific Antigen (PSA)Alkaline
PhosphataseBone Scan
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Alkaline Phosphatase is 157 U/L
PSA is 5.8 ng/ml
Click Here to View the Bone Scan
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Prostate Specific Antigen (PSA)Alkaline
PhosphataseBone Scan
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13
Bone Scan for Case Study 1

• This bone scan uses a calcium analogue attached
  to a radioactive tag. A special scanner can pick
  up images of this radioactivity. Cancer cells
  will pick up and retain an excess of calcium
  because they are more active and thus hold onto
  more radioactive tags than surrounding healthy
  bone tissue. The radiation shows up a black spots
  on the film.

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The patient was not interested in castration and
asked if there was another way to treat this. He
was treated with a single shot of a drug which is
slowly released into the body over a three month
time period. Within that time the patient noticed
a marked relief in pain.
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15
CASE STUDY 2

• CASE OF THE CHILLING SCHOOL TEACHER
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

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PatientReport Form
16
Click on one of the individuals below to gather
information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
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NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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Temperature is 96.8 OF
Height 52Weight 160 lbs
Heart Rate is 46 beats / min
Oxygen Saturation is 91
Patient has never smoked and rarely drinks
alcohol. There has been a weight gain of 20
pounds in the last year. Patient has no nausea
associated with this visit but does experience
constipation. She does complain of being cold.
Patient is an English teacher and has been
married for 17 years.
Blood Pressure is 110/85
Respiration Rate is 12 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is your name?How old are you?What sex are
you? What medications are you on?Do you have
any allergies?Describe your current issue
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20
Three months ago my bowel movements changed to
only once every three days. Previously I would
have bowel movements every day. I fell cold all
of the time, even when my family is comfortable
in a room set a 70 degrees, I feel cold unless I
turn the heat up to 74 degrees.
Milk of Magnesia
Linda Bower
40 years old
Female
No allergies
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What is your Name?How old are you?What sex are
you?Are you on any medications?Do you have any
allergiesDescribe your issue
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DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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22
Patient complains of feeling cold all of the time
even in normal room temperature environments.
Patient also complains of a change in bowel
movements over the last 3 months from 1 bowel
movement per day to 1 bowel movement every three
days despite use of laxatives.
Palpations of the armpits, abdomen, groin all
indicate normally. The thyroid gland is mildly
enlarged and non-tender. A neurological exam
shows deep tendon reflexes like the ankle jerk
showed slight hang-up and the relaxation phase
seemed prolonged. Skin is dry and thinner than
normal.
Clear
Normal
Sclera clear, Ears and Throat no inflammation.
Good
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HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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LAB TECHNICIAN
The Lab Tech can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
Thyroid Stimulating Hormone (TSH)Thyroxine (T4)
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T4 50 nmol /L
TSH 8 mU/L
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Thyroid Stimulating Hormone (TSH)Thyroxine (T4)
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CASE STUDY 3

• CASE OF THE POISON MILK SHAKE
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

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PatientReport Form
26
Click on one of the individuals below to gather
information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
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NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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Temperature is 98.4 OF
Oxygen Saturation is 91
Height 51Weight 110 lbs
Heart Rate is 62 beats / min
Patient does not smoke or drink alcohol. She has
experienced some nausea and diarrhea related to
this visit. She has not eaten any peanuts or
peanut butter in the past two years. Patient is a
graduate student in computer science and not
married.
Blood Pressure is 120 / 75
Respiration Rate is 12 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is your name?How old are you?What sex are
you? What medications are you on?Do you have
any allergies?Where does it hurt?
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30
I have experienced occasional discomfort after
meals. Last Thursday evening about an hour after
eating a cheeseburger and a chocolate milk shake,
I spent most of the night in pain with abdominal
cramps and diarrhea.
Birth Control Pills
Pei Ling
26 years old
Female
Peanut Butter
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What is your Name?How old are you?What sex are
you?Are you on any medications?Do you have any
allergiesWhere does it hurt?
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DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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32
Patient complains of abdominal cramping with
diarrhea. This may be associated with dining out.
Most evenings patient cooks at home and almost
never uses dairy products with no resulting
discomfort. Patient may be lactose intolerant.
Lab will perform tests to verify diagnosis.
Palpations of neck, armpits, abdomen, groin all
indicate normally.
Clear
Normal
Sclera clear, Ears and Throat no inflammation.
Good
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HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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LAB TECHNICIAN
The Lab Tech can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
Blood Glucose
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34
81 mg / dL
Patient has not eaten for two hours previous to
treatment. Patient was given a lactose rich fluid
to drink and had her blood glucose levels checked
periodically for the next two hours.
81 mg / dL
81 mg / dL
81 mg / dL
81 mg / dL
Click on any of the items listed
Blood Glucose Before Treatment After
Treatment 10 minutes After Treatment 30
minutes After Treatment 1 hour After
Treatment 2 hours
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35
The patient was not interested in castration and
asked if there was another way to treat this. He
was treated with a single shot of a drug which is
slowly released into the body over a three month
time period. Within that time the patient noticed
a marked relief in pain.
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36
CASE STUDY 4

• CASE OF THE DOUBLE JOINTED ATHLETE
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

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PatientReport Form
37
Click on one of the individuals below to gather
information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
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NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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39
Temperature is 98.6 OF
Patient does not smoke or drink alcohol. He has
not experienced any nausea but headaches
occasionally related to this visit. Patient is
not married and plays basketball for the local
college. Patient indicates no known history of
any excessive joint mobility, eye problems, or
cardiac disease in the family.
Height 67Weight 225 lbs
Heart Rate is 63 beats / min
Oxygen Saturation is 88
Blood Pressure is 160 / 90
Respiration Rate is 13 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is your name?How old are you?What sex are
you? What medications are you on?Do you have
any allergies?Where does it hurt?
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41
My knees and shoulders have been hurting the last
year all of the time. I have trouble sleeping at
night. When I lie on my side, I feel like my arm
rolls out of my shoulder and causes extreme pain.
I can sometimes feel my heart beating and I am
tired most of the time. My fingers will sometimes
pop out of joint but they always pop back in
to place.
Aspirin 2-3 per day for pain
Marty Fanstrom
20 years old
Male
None
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What is your Name?How old are you?What sex are
you?Are you on any medications?Do you have any
allergiesWhere does it hurt?
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DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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43
Systolic murmur consistent with mitral
regurgitation
Palpations of neck, armpits, abdomen, groin all
indicate normally. Patient is somewhat slender,
with a slightly depressed chest (pectus
excavatum). He has no scoliosis. He demonstrated
that his arm span is seven inches longer than his
height. His fingers appeared somewhat long. The
arches of his feet appeared normal. Patient has
excessive joint mobility.
Patient currently has chronic knee and shoulder
pain. Sleeping is often difficult if he sleeps
lying on his side, he feels like his humerus
rolls out of his shoulder socket and pinches some
nerves. An echocardiogram was ordered indicating
mitral regurgitation and a 3.5 centimeter
thoracic aortic aneurysm.
Clear
Sclera clear, Ears and Throat no inflammation
Poor
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Click here to view the echocardiogram
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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LAB TECHNICIAN
The Lab Tech can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
Genetic analysis
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Genetic analysis using mutational screening
indicates a positive result for the mutant FBN1
gene
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Click here to view the Genetic Analysis
Genetic Analysis
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Echocardiogram for Case Study 4
An echocardiogram displaying the true lumen and
false lumen of an aortic dissection. In the image
to the left, the intimal flap can be seen
separating the two lumens. In the image to the
right, color flow during ventricular systole
suggests that the upper lumen is the true lumen.
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Genetic Analysis for Case Study 4
The FBN1 gene provides instructions for making a
protein called fibrillin. Fibrillin is a critical
protein in microfibrils. Microfibrils become part
of elastic fibers, which enable the skin,
ligaments, and blood vessels to stretch.
Microfibrils also hold certain growth factor
proteins, and keep them inactive. When released
from microfibrils, these growth factors are
activated and affect the growth and repair of
tissues throughout the body. FBN1 mutations
reduce the amount of fibrillin produced by the
cell. As a result, the amount of fibrillin
available to form microfibrils is severely
reduced. Decreased microfibril formation weakens
the elastic fibers and causes release of normally
contained growth factors, which leads to the
signs and symptoms of Marfan syndrome. Image A
below shows the chromosomes from a white blood
cell from the patient with one of the Chromosome
15 alleles circled in yellow. Image B shows
Chromosome 15. The lighter glow we see near the
bottom of the chromosome are the result of
genetic marker tags which have attached to the
FBN1 gene. These marker tags will only attach to
defective FBN1 genes. This would indicate that
there is a defective FBN1 gene on Chromosome 15
producing a positive test for Marfan Syndrome.
Image C is a sketch of chromosome 15 with the
arrow pointing to the location of the FBN1 gene.
A
B
C
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CASE STUDY 5

• CASE OF THE FORGETFUL SOCCER MOM
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

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PatientReport Form
49
Click on one of the individuals below to gather
information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
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NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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51
Patient does not smoke and consumes alcohol
occasionally. She has not experienced any nausea
but headaches occasionally related to this visit.
Patient has been married for 10 years and works
as a Physical Education instructor and coaches
soccer. Patient indicates no known history of
neurogenerative disease in the family but has
some vague recollection of her grandfather in a
wheelchair when she was really young, but did not
know what was wrong with him
Temperature is 98.6 OF
Oxygen Saturation is 95
Heart Rate is 64 beats / min
Height 57Weight 129 lbs
Blood Pressure is 120 / 80
Respiration Rate is 12 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is your name?How old are you?What sex are
you? What medications are you on?Do you have
any allergies?What seems to be the problem?
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53
I am not able to concentrate at work and I am
becoming extremely forgetful. I have had a few
fainting spells at soccer games the last few
weeks. I have had trouble typing making more
errors than usual and my fingers will go numb
often. I have been feeling very tired and my
coordination seems off. The problems seem to come
and go.
Phyllis Barthow
32 years old
None
Female
None
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What is your Name?How old are you?What sex are
you?Are you on any medications?Do you have any
allergiesWhat seems to be the problem
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DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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Heart sounds are normal
Palpations of neck, armpits, abdomen, groin all
indicate normally. Patient performs poorly in
coordination tests in following moving object
with both eyes.
Patient complains of recurring fainting spells
and numbness and tingling in the fingers.
Coordination tests have proven a below average
score. Preliminary tests exclude pregnancy or
menopause. I am scheduling a CSF (cerebrospinal
fluid) work up and an MRI and a Dark Fluid MRI
Clear
Sclera clear, Ears and Throat no inflammation
Good
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Click here to view the MRI Tests
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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LAB TECHNICIAN
The Lab Tech can supply you with the information
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to access the information you require for
yourPatient Report.
Cerebrospinal Fluid (CSF) Test
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CSF test show elevated levels of myelin basic
protein
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Cerbrospinal Fluid (CSF) Test
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58
MRI for Case Study 5
Magnetic Resonance Imaging (MRI) The MRI machine
takes pictures of the brain in slices. The dark
areas are the brain tissue and the white areas in
the middle and around the outside are the
cerebrospinal fluid. The white dots indicate
plaques or scars in the brain, which evokes
multiple sclerosis. In Dark Fluid MRI the
cerebrospinal fluid does not show up white. The
evoked MS tests and the elevated levels of myelin
basic protein in you cerebrospinal fluid indicate
the same thing. Patient is probably suffering
from relapsing-remitting multiple sclerosis (MS),
in which relapses of symptoms are separated by
periods of remission. MS is a disorder in which
the myelination of axons is degraded due to
unknown factors. The most commonly accepted
explanation is that MS is an autoimmune disorder
in which myelin in the central nervous system is
attacked by the bodys own immune system.
Physical therapy, weekly injections of interferon
beta, and corticosteroids have been ordered.
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Normal MRI imaging. The white spots you see are
plaques indicating MS.
Dark Fluid MRI
59
CASE STUDY 6

• CASE OF THE SALTY BABY
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

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PatientReport Form
60
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information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
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NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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Temperature is 98.6 OF
Height 31Weight 29 lbs
Heart Rate is 115 beats / min
Oxygen Saturation is 89
Patient was adopted two weeks ago with no known
history of the parents health. Patient is a
happy, energetic child. Sputum being coughed up
is green and viscid. Mother states that the
childs skin tastes a bit salty whenever she
kisses him on the cheek. Patient does exhibit a
runny nose.
Blood Pressure is 95 / 60
Respiration Rate is 30 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is the childs name?How old is the
child?What sex is the child? What medications
is the child on?Does the child have any
allergies?What seems to be the problem?
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64
Sam was adopted two weeks ago and very little is
known of his biological parents. Sam has had all
the proper immunizations for his age. We have
noticed some greasy/oily stools in his diaper and
we are concerned about his wheezing (when
breathing).
Sam Carter
3 years old
½ baby aspirin / day
Male
None Known
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What is the childs Name?How old is the
child?What sex is the child?What medications is
the child on?Does the child have any
allergies?What seems to be the problem?
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DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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Heart sounds are normal
Patient exhibits a white frosting on his face
indicating a salty build-up on the drying edge of
sweat. Mother states that she has observed this
before. We are ordering a Complete Blood Count
and chest X-ray. We will also order a Sweat
Chloride Test.
Cracking sounds are present, coughing and
wheezing are noticeable
Palpations of neck, armpits, abdomen, groin all
indicate normally. Full mobility is present with
normal reflexes. Pulse is good in arms and legs.
Sclera clear, Ears clear of any fluid, runny nose
Good
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Click here to view the Chest X-Ray
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
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LAB TECHNICIAN
The Lab Tech can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
Complete Blood CountSweat Chloride Test
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White blood cell count values within normal
limits. White blood cell differential
lymphocytes, monocytes, eosinophils, and
basophils are within normal limits. There is a
slight elevation in neutrophils. Red blood cell
count values within normal limits Hematocrit
values within normal limits Platelet count
values within normal limits
Results are 65 meq / L
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Complete Blood CountSweat Chloride Test
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Chest X-Ray for Case Study 6
Chest X-Ray indicates some hyperinflation and
apparent bronchial wall thickening and dilatation.
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CASE STUDY 7

• CASE OF THE SKINNY RUNNER
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

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PatientReport Form
71
Click on one of the individuals below to gather
information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
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NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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73
Temperature is 97.7 OF
Patient is an avid runner in training for her
upcoming Figure Skating season. Patient claims to
weigh over 120 lbs. Discussion with her mother
indicates that the patient does not eat well and
has often skipped numerous meals during the day.
Patient drinks only water after running, claiming
to dislike the sweet taste of sports drinks.
Patient is very driven to succeed in skating and
claims to have no time for socializing with boys.
Height 58Weight 101 lbs
Heart Rate is 65 beats / min
Oxygen Saturation is 88
Blood Pressure is 88 / 56
Respiration Rate is 13 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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74
PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is the your name?How old are you?What sex
are you? What medications are you on?Do you
have any allergies?What seems to be the problem?
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75
I always feel cold. I sometimes feel light-headed
and I fainted at home earlier today. When I
fainted my mom put my feet up on a chair and I
regained consciousness in just a few minutes. I
feel hungry most of the time and I do not seem to
have the energy I used to. I have to get better
soon because I start skating competitions soon,
and they run through the end of the year. I have
always dreamed of getting to the Olympics.
Suzie Jones
15 years old
None
Female
None
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What is your Name?How old are you?What sex are
you?What medications are you on?Do you have any
allergies?What seems to be the problem?
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DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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77
Some ectopic beats
Patient indicates a low fat diet with low caloric
intake. Patients last period was 3 months ago.
Cardiac output is calculated at 3.6 L. A body fat
test puts the patient in the LOW percentile.
Patient exhibits higher than normal levels of
edema. We are ordering a full blood work up.
Clear
Palpations of neck, armpits, abdomen, groin all
indicate normally. Full mobility is present with
normal reflexes. Pulse is good in arms and legs.
Patient is under weight and ribs and shoulder
blades are extremely evident. Patients skin is
pale and flaky.
Sclera clear, Ears and throat indicate no
inflammation
Poor
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HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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LAB TECHNICIAN
The Lab Tech can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
Blood work up
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79
Hematocrit 32 RBC Pale Immature Estrogen
Low Fasting Glucose 55 mg / mL Sodium 126 mmol
/ L Potassium 2.4 mmol / L Calcium 2.9 mmol /
L Protein 3.9 g / dL Iron 38 ug / dL
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Blood Work up
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80
Doctors Diagnosis for Case Study 6
Patient is suffering from what is known as the
female athletes triad a combination of
disordered eating, loss of your period, and
osteoporosis. Rigid eating habits and strenuous
training regimen have produced loss of menses,
and osteoporosis is likely to develop without
intervention. Patient exhibits most symptoms for
anorexia nervosa and the extreme exercise
regimen is making things worse. The patient is
extremely driven to be in great shape for her
skating season. I am recommending the patient to
an eating disorder counselor. Continued behavior
at this pace will land the patient in the
hospital in less than a month. Enough data is in
hand to admit the patient to a hospital where
food intake can be monitored.
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81
CASE STUDY 8

• CASE OF THE UPTIGHT STUDENT
• You will be presented with 4 individuals
• that will provide you with information you
• will need to gather to input to your
• PATIENT REPORT. When you have finished
• with each of the medical personnel reports
• you will be provided with questions to
• answer concerning the Case Study.

Back to CaseStudies Index
Perform theCase Study
PatientReport Form
82
Click on one of the individuals below to gather
information to record on your Patient Report
Patient
Lab Tech
Doctor
Nurse
Back to CaseStudies Index
83
NURSE
The Nurse can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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84
Temperature is 98.6 OF
Patient does not smoke or drink and lives in a
household that does not have any smokers. She has
not experienced any nausea or headaches related
to this visit. Patient skin color is dusky.
Patient is not married and is high school student.
Heart Rate is 108 beats / min
Height 55Weight 124 lbs
Oxygen Saturation is 92
Blood Pressure is 120/76
Respiration Rate is 20 breaths / min
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BLOOD PRESSUREHEART RATEHEIGHT AND
WEIGHTRESPIRATION RATETEMPERATUREOXYGEN
SATURATIONPATIENT HISTORY
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85
PATIENT
The Patient can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
What is your name?How old are you?What sex are
you? What medications are you on?Do you have
any allergies?Where does it hurt?
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86
My chest tightens that causes me to cough.
Breathing out is more difficult than breathing
in. If I lean forward it is easier to breathe.
Zoe Peterson
No medications
17 years old
Female
No allergies
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What is your Name?How old are you?What sex are
you?Are you on any medications?Do you have any
allergiesWhere does it hurt?
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87
DOCTOR
The Doctor can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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88
Patient has experienced reversible, periodic
attacks of chest tightness with coughing,
wheezing and hyperpnea. She states that
expiration is more difficult than inspiration.
She is most comfortable sitting forward with arms
leaning on some support.
Palpations of neck, armpits, abdomen, groin all
indicate normally
Wheezy, Rhonchi
Normal
Sclera clear, Ears no inflammation, Throat
slightly red
Good
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HEART SOUNDSLUNG SOUNDSEYES, EARS AND
THROATCAPILLARY REFILLPALPATATIONSPATIENT
INTERVIEW
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89
LAB TECHNICIAN
The Lab Tech can supply you with the information
listed below. Click on any of the listings below
to access the information you require for
yourPatient Report.
Vital Capacity (VC)Forced Expiratory Volume
(FEV)FEV / FVCFunctional Residual Capacity
(FRC)Total Lung Capacity (TLC)PaO2PaCO2X-Ray
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90
FEV is 1.4 L in 1 min
TLC is 6.82 L
VC is 2.9 L
PaO2 is 70 mm Hg
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FEV / FVC ratio is 56
FRC is 3.89 L
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PaCO2 is 26 mm Hg
Vital Capacity (VC)Forced Expiratory Volume
(FEV)FEV / FVCFunctional Residual Capacity
(FRC)Total Lung Capacity (TLC)PaO2PaCO2X-Ray
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91
X-ray for Case Study 8

• This X-ray reveals mild over-inflation of the
• chest

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92
The Doctor has ordered the intermittent use of a
bronchial dilator (11000 epinephrine by
nebulizer) for one week. Click on the LAB TECH to
view laboratory and pulmonary function tests
after treatment.
93
FEV is 3.1 L in 1 min
TLC is 5.96 L
VC is 4.15 L
PaO2 is 89 mm Hg
FEV / FVC ratio is 78
FRC is 3.7 L
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PaCO2 is 38 mm Hg
Vital Capacity (VC)Forced Expiratory Volume
(FEV)FEV / FVCFunctional Residual Capacity
(FRC)Total Lung Capacity (TLC)PaO2PaCO2
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94
END

• END